Dermatitis and Eczema Practice Questions

Q: The Hanifin & Rajka diagnostic criteria are used for which condition?

Atopic dermatitis. **Explanation:** The **Hanifin and Rajka criteria** (established in 1980) are the traditional "gold standard" for diagnosing **Atopic Dermatitis (AD)**. Because there is no specific laboratory biomarker for AD, diagnosis relies on clinical morphology and history. To satisfy the criteria, a patient must meet at least **3 out of 4 Major features** and at least **3 out of 23 Minor features**: * **Major Criteria:** Pruritus (itching), Typical morphology and distribution (e.g., facial/extensor involvement in infants, flexural lichenification in adults), Chronic or chronically relapsing dermatitis, and Personal/family history of atopy (asthma, allergic rhinitis, AD). * **Minor Criteria:** Include xerosis, ichthyosis, elevated serum IgE, early age of onset, Dennie-Morgan infraorbital fold, keratosis pilaris, and white dermographism. **Why other options are incorrect:** * **Contact Dermatitis:** Diagnosed primarily via clinical history and **Patch Testing** (to identify Type IV hypersensitivity allergens). * **Urticaria:** Characterized by transient wheals and angioedema; diagnosis is clinical, often involving the **UAS7 (Urticaria Activity Score)** for severity. * **Erythroderma:** A clinical state (exfoliative dermatitis involving >90% body surface area) caused by various underlying conditions like psoriasis or drugs; it does not use these specific criteria. **High-Yield Clinical Pearls for NEET-PG:** * **UK Working Party Criteria:** A simplified version of Hanifin & Rajka often used in clinical trials (requires Itch + 3 or more minor criteria). * **Dennie-Morgan Fold:** An extra fold of skin under the lower eyelid, a classic minor sign of AD. * **Hertoghe’s Sign:** Thinning of the lateral third of the eyebrows (seen in AD and Hypothyroidism). * **Pathogenesis:** Often involves **Filaggrin (FLG) gene mutations**, leading to skin barrier defects.

Q: A 17-year-old female presents with a pruritic rash localized to the wrist. Papules and vesicles are noted in a bandlike pattern, with slight oozing from some lesions. What is the most likely cause of this rash?

Contact dermatitis. ### Explanation **Correct Answer: C. Contact Dermatitis** The clinical presentation of a pruritic rash localized to the wrist in a "bandlike pattern" is a classic description of **Allergic Contact Dermatitis (ACD)**. In this case, the pattern strongly suggests an exogenous trigger, most commonly **Nickel**, found in wristwatches, bracelets, or metallic straps. ACD is a **Type IV (Delayed) Hypersensitivity reaction**. The acute phase is characterized by erythematous papules, vesicles, and oozing (as seen here), while the chronic phase presents with lichenification and scaling. The most defining feature for NEET-PG is the **morphology conforming to the shape of the offending agent** (e.g., a band for a watch, a circle for a bindi, or a linear streak for Poison Ivy). **Why the other options are incorrect:** * **A & B (Herpes Simplex & Shingles):** While both can present with vesicles, they are typically painful or burning rather than primarily pruritic. Shingles (Herpes Zoster) follows a **dermatomal distribution**, not a circumferential bandlike pattern around a limb. * **D (Seborrheic Dermatitis):** This typically affects "seborrheic areas" rich in sebaceous glands, such as the scalp, eyebrows, and nasolabial folds. It presents with greasy, yellowish scales rather than oozing vesicles on the wrist. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Patch Testing (Readings taken at 48 and 72/96 hours). * **Common Allergens:** Nickel (most common worldwide), Potassium dichromate (cement/leather), Paraphenylenediamine (hair dye), and Neomycin (topical creams). * **Management:** Identification and avoidance of the allergen is the most crucial step. Topical corticosteroids are the first-line medical treatment.

Q: Air-borne contact dermatitis can be diagnosed by?

Patch test. ### Explanation **Correct Option: B. Patch Test** Airborne contact dermatitis (ABCD) is a form of **Type IV (Delayed-type) Hypersensitivity** reaction caused by volatile particles, pollens (e.g., *Parthenium hysterophorus*), or dust settling on exposed skin. The gold standard for diagnosing any allergic contact dermatitis, including the airborne variant, is the **Patch Test**. This test identifies the specific allergen by applying suspected substances to the skin under occlusion for 48 hours and observing for an eczematous reaction at 48 and 72/96 hours. **Why other options are incorrect:** * **Skin Biopsy (A):** While a biopsy can confirm the presence of "eczematous tissue changes" (like spongiosis), it is non-specific. It cannot identify the causative allergen or differentiate between types of contact dermatitis. * **Prick Test (C):** This is used to diagnose **Type I (Immediate) Hypersensitivity** reactions, such as urticaria or allergic rhinitis. It is not used for the T-cell mediated delayed response seen in ABCD. * **Serum IgE Levels (D):** Elevated IgE is a marker for **Atopic Dermatitis** or Type I allergies. ABCD is not mediated by IgE antibodies. **High-Yield Clinical Pearls for NEET-PG:** * **Commonest Cause in India:** *Parthenium hysterophorus* (Congress grass). * **Clinical Presentation:** Typically involves "exposed areas" such as the face, eyelids, V-area of the neck, and antecubital fossae. It characteristically **spares** the upper eyelids (due to the deep fold) and the submental area (the "shadow sign"). * **Differential Diagnosis:** Must be distinguished from Photo-allergic dermatitis. ABCD involves the eyelids and skin folds, which are often spared in purely photodermatoses. * **Standard Series:** In India, the **CODSAI** (Contact and Occupational Dermatoses Forum of India) series is commonly used for patch testing.

Q: The following are true regarding the picture shown except:

They are painful but not pruritic. The image displays vesicles on the palms and fingers, characteristic of **dyshidrotic eczema**, also known as **pompholyx**. This condition is primarily characterized by intense itching. ***They are painful but not pruritic*** - Dyshidrotic eczema (pompholyx) is classically described as an intensely **pruritic** condition. - While pain can occur, especially if vesicles rupture or become infected, **pruritus (itching)** is a dominant and defining symptom, making the statement "not pruritic" incorrect. *Topical corticosteroids are usually helpful* - **Topical corticosteroids** are the mainstay of treatment for dyshidrotic eczema and are typically effective in reducing inflammation and itching. - Stronger formulations may be required for severe cases on the palms and soles due to the thick stratum corneum. *Pruritic 'tapioca' vesicles on palms and sides of fingers* - This description perfectly matches the clinical presentation of dyshidrotic eczema, which features deeply-seated, **pruritic vesicles** that resemble **tapioca pudding** on the palms, soles, and sides of the fingers and toes. - The image clearly shows these small, clear vesicles. *50 % of patients have a history of atopy* - Dyshidrotic eczema is frequently associated with **atopy**, with approximately **50% of affected individuals** having a personal or family history of atopic dermatitis, asthma, or allergic rhinitis. - It is considered a variant of eczema, often triggered by internal or external factors in predisposed individuals.

Q: All are true about the lesions shown except:

Potent topical steroids resolve most cases. ***Potent topical steroids resolve most cases*** - This statement is **false** and is the correct answer to this "EXCEPT" question. - Dyshidrotic eczema (pompholyx) is a **chronic, relapsing condition** that often requires long-term management. - While potent topical steroids are the **mainstay of initial treatment**, they typically provide symptomatic control rather than permanent resolution. - **Recurrences are common**, and many patients require ongoing maintenance therapy or additional treatments such as systemic steroids, immunosuppressants, or phototherapy for severe or refractory cases. *Itchy lesions on palms* - Dyshidrotic eczema is characterized by **intensely pruritic vesicles** that typically appear on the **palms, soles, and lateral aspects of the fingers**. - The image clearly shows vesicular lesions on the palms, consistent with this classic presentation. *Associated with atopic diathesis* - There is a **strong association** between dyshidrotic eczema and **atopic conditions** (atopic dermatitis, allergic rhinitis, asthma). - Approximately **50% of patients** with pompholyx have a personal or family history of atopy. - This atopic association is an important epidemiological feature of the condition. *Painful deep seated vesicles* - The vesicles in dyshidrotic eczema are characteristically **deep-seated** (often described as resembling "tapioca pudding"), especially in the early stages. - They can be both **intensely itchy and painful**, particularly when they are tense and before rupture. - The image demonstrates these characteristic deep vesicular lesions.

Q: The image shows:

Atopic dermatitis. ***Atopic dermatitis*** - The image displays characteristic features of **atopic dermatitis**, including **erythema**, **scaling**, and **lichenification**, particularly visible on the foot. - The skin appears dry, thickened, and inflamed, consistent with chronic eczema often associated with atopic dermatitis. *Allergic shiners* - **Allergic shiners** are dark circles under the eyes caused by venous congestion due to allergies, which are not depicted in this image of a foot. - This condition is a facial sign and unrelated to the skin findings shown. *Allergic line* - The term "allergic line" or **Dennie-Morgan folds** refers to extra folds of skin under the lower eyelids, also a facial sign of allergies, not seen here. - The image presents a skin condition on the foot, not a facial feature. *Acute urticaria* - **Acute urticaria** (hives) presents as transient, raised, itchy **wheals** with well-demarcated borders, which are not consistent with the chronic, scaly, and thickened appearance of the skin in the image. - The lesions in the image show thickening and inflammation, typical of a more chronic dermatological condition rather than the transient nature of acute urticaria.

Q: The clinical sign shown in the image is:

Dennie-Morgan fold. ***Dennie-Morgan fold (infraorbital fold)*** - The image clearly shows a prominent **infraorbital fold** or crease below the lower eyelid. - This crease is known as **Dennie-Morgan fold** (also called Dennie-Morgan lines) and is a common finding in individuals with atopic dermatitis or chronic allergic conditions. - It represents an accentuated line or fold in the skin of the lower eyelid and is considered a minor diagnostic criterion for atopic dermatitis. *Allergic salute* - An **allergic salute** refers to the characteristic gesture where a child repeatedly pushes the tip of the nose upward with the palm of the hand to relieve nasal itching and obstruction. - This action often leads to a transverse crease across the bridge of the nose, but it is not depicted in the image. *Allergic line* - The term **allergic line** (or allergic crease) is synonymous with the transverse nasal crease resulting from the allergic salute. - While it's a sign associated with chronic allergic rhinitis, it does not describe the infraorbital fold seen in the image. *Allergic shiners* - **Allergic shiners** are dark, discolored areas under the eyes, resembling bruises, caused by venous congestion secondary to chronic allergic rhinitis or nasal obstruction. - While allergic shiners may coexist with Dennie-Morgan folds, the prominent feature indicated in the image is the infraorbital fold itself, not periorbital darkening.

Q: This patient was cleaning the basement, following which he developed the lesions as shown on his back for the last 6 hours. The image shows presence of:

Acute urticaria. ***Acute urticaria*** - The image shows widespread, erythematous, edematous, and **pruritic wheals** (hives) on the back, consistent with **acute urticaria**. - The sudden onset after cleaning the basement suggests an acute allergic reaction or contact with an irritant, leading to mast cell degranulation and histamine release. *Atopic dermatitis* - This condition typically presents with **eczematous lesions**, characterized by dry, itchy, inflamed skin, often with lichenification in chronic cases. - The lesions in the image are distinct wheals, not the typical presentation of atopic dermatitis. *Cholinergic urticaria* - This form of urticaria is triggered by **increases in body temperature**, such as exercise, hot baths, or emotional stress, rarely by cleaning a basement. - It usually manifests as small, pinpoint wheals surrounded by a flare, which is different from the large, confluent wheals shown. *Dermographism* - **Dermographism** is a physical urticaria where wheals appear along lines of pressure or scratching on the skin, literally "writing on the skin." - While it involves wheals, the distribution in the image is generalized and not confined to areas of pressure or linear scratching, making it inconsistent with dermographism.

Q: The following strip is used for testing of:

Contact dermatitis. ***Contact dermatitis (Allergic)*** - The image depicts a **patch test** strip, characterized by multiple small chambers containing various allergens, which are applied to the skin. - This method is the **gold standard** for identifying specific substances that cause **allergic contact dermatitis** by observing localized inflammatory reactions after 48-72 hours. - Patch testing detects **Type IV delayed hypersensitivity** reactions to specific allergens. *Atopic dermatitis* - While atopic dermatitis is a type of eczema, it is primarily diagnosed based on **clinical criteria** (e.g., pruritus, typical morphology and distribution), family history, and elevated IgE levels. - Patch testing is generally not the primary diagnostic tool for atopic dermatitis, as it is primarily a **Type I hypersensitivity** reaction, whereas patch tests detect Type IV reactions. *Seborrheic dermatitis* - Seborrheic dermatitis is a chronic inflammatory condition affecting sebum-rich areas (scalp, face, chest). - Diagnosis is made **clinically** based on characteristic greasy, yellowish scales in typical distributions. - Patch testing is not used for diagnosis of seborrheic dermatitis. *Irritant contact dermatitis* - Irritant contact dermatitis results from **direct chemical damage** to the skin rather than an allergic immune response. - It is diagnosed primarily through **clinical history** and distribution pattern of lesions. - Patch testing is specifically designed to identify **allergic** (not irritant) contact dermatitis, as irritant reactions are non-immunological.

Question 1

The Hanifin & Rajka diagnostic criteria are used for which condition?

Accepted Answer

Atopic dermatitis

Answer

Contact dermatitis

Answer

Urticaria

Answer

Erythroderma

Question 2

A 17-year-old female presents with a pruritic rash localized to the wrist. Papules and vesicles are noted in a bandlike pattern, with slight oozing from some lesions. What is the most likely cause of this rash?

Accepted Answer

Contact dermatitis

Answer

Herpes simplex

Answer

Shingles

Answer

Seborrheic dermatitis

Question 3

A 25-year-old male presents with recurrent episodes of flexural eczema, contact urticaria, recurrent skin infections, and severe abdominal cramps and diarrhea upon consuming seafood. What is the most likely diagnosis?

Accepted Answer

Atopic dermatitis

Answer

Seborrheic dermatitis

Answer

Airborne contact dermatitis

Answer

Nummular dermatitis

Question 4

Air-borne contact dermatitis can be diagnosed by?

Accepted Answer

Patch test

Answer

Skin biopsy

Answer

Prick test

Answer

Estimation of serum IgE levels

Question 5

The following are true regarding the picture shown except:

Accepted Answer

They are painful but not pruritic

Answer

Topical corticosteroids are usually helpful

Answer

Pruritic 'tapioca' vesicles on palms and sides of fingers

Answer

50 % of patients have a history of atopy

Question 6

All are true about the lesions shown except:

Accepted Answer

Potent topical steroids resolve most cases

Answer

Itchy lesions on palms

Answer

Associated with atopic diathesis

Answer

Painful deep seated vesicles

Question 7

The image shows:

Accepted Answer

Atopic dermatitis

Answer

Allergic shiners

Answer

Allergic line

Answer

Acute urticaria

Question 8

The clinical sign shown in the image is:

Accepted Answer

Dennie-Morgan fold

Answer

Allergic salute

Answer

Allergic line

Answer

Allergic shiners

Question 9

This patient was cleaning the basement, following which he developed the lesions as shown on his back for the last 6 hours. The image shows presence of:

Accepted Answer

Acute urticaria

Answer

Atopic dermatitis

Answer

Cholinergic urticaria

Answer

Dermographism

Question 10

The following strip is used for testing of:

Accepted Answer

Contact dermatitis

Answer

Atopic dermatitis

Answer

Seborrheic dermatitis

Answer

Irritant contact dermatitis

Dermatitis and Eczema — MCQs

Dermatitis and Eczema — MCQs

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